Health problems of Lithuanian and Latvian seamen Jonas Sąlyga , 38

ACTA MEDICA LITUANICA. 2006. VOLUME 13 No. 1. P. 38–46
© Lietuvos mokslų akademija, 2006
38
Jonas Sąlyga, Algirdas Juozulynas, Aloyza Lukšienė
© Lietuvos mokslų akademijos leidykla, 2006
Health problems of Lithuanian and Latvian seamen
Jonas Sąlyga1,
Algirdas Juozulynas2*,
Aloyza Lukšienė2
Klaipėda Seamen’s Hospital,
Liepojos 45, Klaipėda, Lithuania.
E-mail: [email protected]
1
Vilnius University Institute of
Experimental and Clinical Medicine
Žygimantų 9, Vilnius, Lithuania.
E-mail: [email protected]
2
The cross-national study was performed during November–December 2003 in
Lithuanian and Latvian seamen population according to an international
Lithuanian–Latvian concerted research technique. The aim of the study was
to evaluate the self-reported and the objective health status of Lithuanian and
Latvian seamen.
The evaluation of the health status of Lithuanian and Latvian seamen
showed that nearly two-thirds of seamen evaluated their health as “good”,
one-third as “quite good”, and nearly 7% of the respondents as “average”.
Lithuanian and Latvian seamen pointed out the following main health-related
problems at sea: pain (toothache, headache, waist pain, and joint pain), insomnia, and chronic diseases – arterial hypertension, gastric and duodenal
ulcers, arthritis, spinal diseases, etc. Among Lithuanian and Latvian seamen,
56.0% indicated that the main cause of morbidity was work at sea being
exposed to health-damaging factors. The results of retrospective analysis of
seamen’s medical documentation showed no statistically significant difference
between Lithuanian and Latvian seamen concerning the frequency of diagnosed diseases: 13.8% of seamen (14.5% of Lithuanian and 13.1% of Latvian
seamen) were diagnosed with various diseases. Those related to seamen’s
professional group were cardiovascular (p < 0.05) and auricular (p < 0.001)
diseases. Cardiovascular diseases were more frequently diagnosed among seamen of the managing (9.2%) and auxiliary (7.9%) sectors, and auditory disorders were more common among seamen of the mechanical ship services
(3.1%, p < 0.05, versus deck crews – 0.6%). These diseases were least
common among deck crews who, compared to the other professional groups,
were more frequently diagnosed with diseases of the connective tissue and
the musculo-skeletal system. They also presented better subjective evaluations of their health status.
Key words: seamen, cross-national comparison, self-reported health, objective
health status, risk factors
INTRODUCTION
The significance of maritime business for Lithuanian
economics is indisputable. At January 1st, 2005 the
Lithuanian registry of mariners listed 11,823 seamen.
More than 4,000 of them work on Lithuanian and the
rest on foreign ships. At present, Lithuania is modernizing its ships, the ships are supplied with newest technologies, the crews are becoming smaller, the duration
of stays in foreign ports is decreasing, and the need for
highly qualified seamen is rising. The physical and social environment on the ships changes, and so do interrelationships among seamen; this, in turn, influences
the seamen’s physical and mental health. Because of
the special psychosocial environment, including a very
special planning of working hours, lifestyle factors like
* Corresponding author.
tobacco, alcohol and food habits are important to disease pattern in the maritime industry (1–5).
Despite the relevance of the problem, there are hardly
any scientific studies on seamen’s health and lifestyle.
However, there has been an increase in the interest in
information on seamen’s working environment and lifestyle risk factors (RF) that affect their health, as well
as in the search for the methods of standardization of
indices of different areas, necessary for comparing the
efficiency of preventive programs.
About 1.2 million seamen are engaged in the maritime business worldwide. The rapid globalization requires comparative studies of seamen’s working environment, with the aim to elaborate the common health and
working environment safety standards (1, 4, 5). In many sea countries, the aim of the studies and projects
initiated on the national or international level is to investigate the psychosocial stress and professional health
Health problems of Lithuanian and Latvian seamen
in the seamen’s population, to reveal the new regularities of the impact of factors of the physical and the
social environment, and to search for new effective
methods to control these factors (1, 2, 6–10). The same
objectives are raised in Lithuania as well. The present
study describes the health and lifestyle behaviour of a
large sample of the Lithuanian and Latvian seafaring
population.
The aim of the study was to evaluate the self-reported and the objective health status of Lithuanian and
Latvian seamen.
MATERIALS AND METODS
The study contingent. The inquiry embraced the respondents that made up the target population, i.e. seamen reporting for compulsory health check-up. In total,
2050 questionnaires were distributed. 1989 (97.0%) filled questionnaires were received, of which 1984 (99.7%)
were selected as suitable for the analysis. The data were accumulated in a database created using Microsoft
Access computer software.
The case group consisted of 998 Lithuanian male
seamen aged 20 to 64 years, who underwent health
examination at the Maritime Medicine Center of Klaipėda Seamen’s Hospital.
The comparison group consisted of 986 Latvian seamen aged 20 to 69 years, who underwent health examination at Riga Maritime Medicine Center. Latvian
seamen were investigated on the basis of the cooperation agreement between Latvian Maritime Medicine Center and Klaipėda Seamen’s Hospital signed on May 12,
2002.
The study was performed during November–December 2003. The mean age of Lithuanian and Latvian
seamen was 40.4 (standard deviation (SD) 11.0) years:
the mean age of Lithuanian seamen was 40.8 ± 10.2
years and of Latvian seamen 40.0 ± 11.7 years.
Methods. Data for the study were obtained using
the method of a sociological questionnaire-based inquiry. Each Lithuanian and Latvian mariner applying for
the compulsory health check-up received a questionnaire containing 44 questions. The questionnaire evaluated
the following: 1. General data (7 questions), 2. Medical
service and health (7 questions), 3. Smoking habit (6
questions), 4. Food habits (6 questions), 5. Alcohol consumption (4 questions), 6. Weight, height, and physical
activity on the ship (6 questions), 7. Unhealthy factors
on sea (7 questions), 8. Other issues (1 question).
The subjective health status was evaluated according to the subjects’ answers (good, quite good, average, quire bad, and bad). In order to analyze the health
problems, the answers to the questions of the questionnaire were dichotomized into the following: 1) good
evaluation of one’s health and 2) less that good evaluation of one’s health (people with health problems).
In order to perform an objective evaluation of the
health status, a retrospective analysis of the documen-
39
tation on mariners’ health was performed; the analysis
included evaluation of the prevalence of diseases diagnosed according to the criteria of the International Classification of Diseases (ICD).
Evaluation of risk factors. Overweight (according to
the WHO criteria) was diagnosed when the body mass
index (BMI) was 25.0–29.9 kg/m2 and obesity when
the BMI was ³30.0 kg/m2. A person who at the time of
the study stated that he was smoking was considered to
be a smoker. Alcohol consumption was considered as
an additional RF when the subjects indicated that they
consumed alcoholic drinks while at sea. Psycho-emotional stress (PS) was assessed as an RF in all seamen
(subjective evaluation of the experienced PS); PS can
be caused by unusual working and life conditions, changes in time and climate zones, the influence of the
electromagnetic field, changes in the sexual life, etc.
Subjectively experienced PS was evaluated by the answers to the question “Did you experience PS during
the last year (12 months) when working on the ship?”
Physical activity on the ship was assessed by asking
the subjects about regular physical exercises: “Do you
frequently exercise (run, etc.) on the ship for at least
30 minutes so that your breathing becomes more rapid
and you perspire”. The possible answers were the following: every day, 4–6 times per week, 2–3 times per
week, once a week, 2–3 times pr month, several times
per year or less frequently, and cannot exercise because
of a disease or disability.
Statistical analysis of the data. The descriptive analysis of the lifestyle determinants was performed using
standard statistical indices: for the continuous variables
– the arithmetic mean of the parameters, 95% confidence interval (CI), SD, dispersion. The hypothesis of
the dispersion equality was verified using Levene’s test.
In cases of non-parametric variables, statistical significance between the proportions was evaluated using the
c2 criterion. Spearman’s rank correlation was used to
determine the rank value interrelationships. When verifying the hypothesis of the equality of the frequency of
separate index groups and having determined that p <
0.05, the hypothesis was discarded and the difference
in the frequency of indices was considered to be statistically significant. The interaction between health status and risk factors was analyzed using the logistic
regression method. When age was expected to play a
role in the results (self-reported health data, health-related behaviour, and PS), logistic regression or ordinal
regression analysis techniques were used to ensure a
comparison of the groups accounting for their age profiles. The data were analyzed with SPSS 11.5.
RESULTS AND DISCUSSION
Socio-demographic characteristics of Lithuanian and
Latvian seamen. The evaluation of Lithuanian and Latvian seamen’s mean age showed that the mean age of
Lithuanian and Latvian seamen was, respectively, 40.8
40
Jonas Sąlyga, Algirdas Juozulynas, Aloyza Lukšienė
(95% CI 40.2–41.4) and 40.0 (95% CI 39.3–40.7) years.
Socio-demographic data on seamen of both countries
are presented in Table 1.
The majority of seamen in both countries were over
40 years of age. There was a significant difference in
the seamen’s distribution in ten-year age groups (c2 =
36.08, p < 0.001). The number of Lithuanian seamen
was less in the age group of up to 25 years, but
greater in the age group of 35–54 years compared to
Latvian seamen (respectively, 65.2% and 54.0%). More
Latvian seamen, compared to Lithuanians, were older
than 54 years of age (Latvian – 11.3%, Lithuanian
7.4%).
Lithuanian seamen’s mean length of service was 11.9
(95% CI 11.3–12.5) years and of Latvian seamen 9.9
(95% CI 9.4–10.4) years. Most seamen of both countries worked for 1 to 10 years at sea. Every fourth
Lithuanian seaman and every fifth Latvian seaman worked for 11–20 years (respectively, 27.6% and 20.4%).
18.1% of Lithuanian seamen and 12.4% of Latvian seamen worked for over 20 years at sea.
In comparison to international shipping data, a higher percentage of Lithuanian and Latvian seamen re-
main in the industry for longer than 10 years. International data indicated that only 12% remained at sea
after the same period (2).
Self-report of duration of the latest tour of duty was
the following: in Lithuanian seamen – 6.4 (95% CI
6.3–6.5) months and in Latvian seamen 6.5 (95% CI
6.4–6.6) months. 51.2% of Latvian seamen and 45.4%
of Lithuanian seamen spent more than 6 months at sea.
We did not find any significant differences when analyzing these data according to different types of ship.
Lithuanian and Latvian seamen’s length of service according to positions occupied was similar, and no significant differences were found between Lithuanian and
Latvian seamen working in the same positions.
Evaluation of medical service and self-reported
health status among Lithuanian and Latvian seamen. The evaluation of the health status of Lithuanian
and Latvian seamen showed that nearly two-thirds of
seamen evaluated their health as “good”, one-third as
“quite good”, and nearly 7% of the respondents as “average”. In addition to that, we detected a statistically
significant difference in the subjective evaluation of the
health status between the seamen of the two neighbo-
Table 1. Socio-demographic characteristics of the study cohort
Characteristic
Age, years
20–24 m.
25–34
35–44
45–54
55–64
>64
Education level
Unfinished secondary
Secondary
Specialized secondary
Higher
Professional groups
I. Management
II. Management with combined specialties
III. Mechanical ship service
IV. Specialists of radionavigation equipment
V. Deck crew
VI. Specialists of non-self-propelled ship and ferries
VII. Auxiliary ship segment
Type of ship
Sea transport
Trawler
Local water transport
Length of service, years
<1
1–10
11–20
>20
Lithuania
Latvia
N (%)
N (%)
77 (7.7)
197 (19.7)
329 (33.0)
321 (32.2)
74 (7.4)
–
132 (13.4)
211 (21.4)
262 (26.6)
270 (27.4)
104 (10.5)
7 (0.7)
12 (1.2)
216 (21.6)
538 (53.9)
232 (23.3)
14 (1.4)
256 (26.0)
536 (54.4)
180 (18.2)
180 (18.0)
5 (0.5)
404 (40.5)
2 (0.2)
339 (34.0)
2 (0.2)
66 (6.6)
171 (17.3)
0
400 (40.6)
3 (0.3)
350 (35.5)
1 (0.1)
61 (6.2)
643 (64.4)
338 (34.0)
17 (1.7)
669 (67.8)
301 (30.6)
16 (1.6)
15 (1.5)
527 (52.8)
275 (27.6)
181 (18.1)
11 (1.1)
649 (65.8)
201 (20.4)
125 (12.7)
χ2
p
36.08
<0.001
10.41
<0.05
7.54
>0.05
3.43
>0.05
30.84
<0.001
41
Health problems of Lithuanian and Latvian seamen
80
60
Latvia
Lithuania
65.7
Latvia
55.6
38.8
% 40
8.2
8.2
0.1 0
Insomnia
Quite good
Average
Quite bad
Fig. 1. Distribution of Lithuanian and Latvian seamen according to their health status evaluation
ring countries (χ = 39.59, having evaluated the age
difference p < 0.01). More Lithuanian seamen compared to Latvians evaluated their health as “good” (65.7%
and 55.6%, respectively) (Fig. 1).
Lithuanian and Latvian deck crew specialists differently evaluated their health status. About three-fourths
of the Lithuanian deck crewmembers (75.5%) evaluated
their health as “good” and 19.2% as “quite good”. Meanwhile, 63.7% of Latvian seamen evaluated their health as “good” and one-third (33.8%) as “quite good”.
A small percentage of seamen in both groups evaluated
their health as “average” (Lithuanians 5.3%, Latvians
2.5%).
Medical service. The analysis of the findings showed
a statistically significant relationship between Lithuanian and Latvian seamen according to their satisfaction with medical services (c2 = 37.42, p < 0.001).
About 40.2% of Lithuanian seamen and only 29.1% of
Latvians were fully satisfied with medical services on
the ship; 30.8% of Lithuanians and 34.2% of Latvians
were satisfied partially, and only 4.3% of Lithuanians
and 8.9% of Latvians were dissatisfied. Although the
number of Lithuanian seamen who evaluated their health as “good” was significantly greater compared to
Latvian seamen, there was no significant difference between Lithuanian and Latvian seamen concerning the
frequency of applications to ship physicians. About onefourth of seamen of both countries had applied to the
ship physician during the last year; there was no significant difference between Lithuanian and Latvian seamen concerning the frequency of applications to the
physician. Lithuanian seamen on the shore applied to
their physicians two times more frequently than when
being at sea, whereas Latvian seamen applied to their
physicians with equal frequency both on the shore and
at sea.
The cases of applications to the physician while at
sea were similar among the seamen of both countries.
Most common reasons for applications were toothache
(Lithuanians 8.2%, Latvians 9.9%), headache (4.8 and
5.5%), and pain in the waist (3.5 and 2.3%). We found
possible tendencies (p < 0.1) of more frequent applications of Lithuanian seamen compared to Latvians related to chest pain during physical exertion (0.3 and 0.0%,
respectively), and pain in the joints (2.4 and 1.3%), the
waist (3.5 and 2.3%), and the neck and shoulders (1.0
9.9
0.3
0.5
Depression
5.6
0
Good
Lithuania
Toothaches
26
20
4.6
5.3
Other
1.2
2.2
+
5.5
4.8
Headaches
Constipation
0.8
0.4
Ithing. rashes
0.4
0.7
2
0.2
0.1
Varicose veins
0.5
0.3
Foot swelling
0.4
1 +
Pain in neck and shoulders
2.3
Waist pain
3.5 +
1.3
Joint pain
2.4 +
0
0.3
Chest pain on physical exertion
0
%
+
2
4
6
8
10
12
+ p < 0.1 (possible difference tendency)
Fig. 2. Distribution of Lithuanian and Latvian seamen according to the reasons for applications to ship physicians
and 0.4%). Latvian seamen more frequently complained of insomnia (2.2%) compared to Lithuanians (1.2%).
Other complaints included common cold-related disorders (1.0 and 1.2%, respectively), traumas (0.4 and
1.1%), and (among Lithuanians) influenza (0.6%). There were individual cases of prostate, hepatic and abdominal pains, as well as eye inflammation (Fig. 2).
Results of self-reported health status are shown in
Fig. 3. The predominant diseases among Lithuanian and
Latvian seamen in whom certain diseases were detected
(according to the seamen’s answers) were arterial hypertension, spinal diseases, gastritis, and gastric and duodenal ulcers. Arterial hypertension was more common
among Lithuanian seamen (3.7% and 1.0%, p < 0.001),
whereas spinal diseases were more common among Latvian seamen (2.7% and 1.9%, p < 0.05). However, rheumatoid arthritis was more common among Lithuanians
than among Latvian seamen (0.7% and 0.1%, p < 0.05).
The univariate logistic regression analysis of the
whole seamen contingent of both countries showed that
the following conditions were significantly related to
older age (>45 years): arterial hypertension (AH) (compared to younger people, OR = 3.7; 95% CI 1.9–7.3)
and hypercholesterolemia (OR = 6.6; 95% CI 1.2–35.8);
among disorders in the ship – joint pain (OR = 2.3;
95% CI 1.1–4.5), waist pain (OR = 2.6; 95% PI 1.4–
4.5), and foot swelling (OR = 4.3; 95% CI 0.8–22.3; p
= 0.08). Most common diseases among Lithuanian seamen over 45 years of age were AH (OR = 3.4; 95%
CI 1.6–7.1) and spinal diseases (OR = 7.8; 95% CI
42
Jonas Sąlyga, Algirdas Juozulynas, Aloyza Lukšienė
2.2–27.5), and among Latvian seamen – AH (OR =
7.9; 95% CI 1.3–46.5).
Analysis of differences in the prevalence of risk factors of chronic non-infectious diseases among different
social groups of Latvian seamen showed that only the
prevalence of AH was statistically significantly related
Gastritis. gastric and
duodenal ulcers
1.1
*
Latvia
0.8
Lithuania
0.2
0.1
Bronchial asthma
0.5
Chronic bronchitis
0.7
Spinal diseases
2.7
*
1.9
0.1
Rheumatoid arthritis
0.7
*
Heart failure
0
0.1
Angina pectoris
0.1
0.3
0.2
MI
0
0.2
Diabetes
0.5
0.5
Hypercholesterolemia
0.6
1
Hypertension
3.7
***
*p < 0.05 ***p < 0.001
0
%
1
2
3
4
5
Fig. 3. Self-reported health status for the entire maritime sample
to the seamen’s education level. As in the case of Lithuanian seamen, the prevalence of overweight and AH
among Latvians increased with age. Each year of age,
like in case of Lithuanian seamen, by 11% increased
the risk for AH. The study did not show any relationship of the prevalence of smoking and alcohol consumption with the level of seamen’s education.
The most prevalent factor in the group of risk factors of chronic non-infectious diseases was smoking –
about 72.6% of respondents were smokers or ex-smokers. The mean duration of smoking was 15.9 years.
The smoking habits of the majority of Latvians (60.9%)
at sea were the same as on shore (47.9% of Lithuanians), and 29.9% of Latvian seafarers smoke more frequently at sea than on shore (Lithuanians 19.6%); 58.5%
of Lithuanian seamen and 48.2% of Latvian seamen
used alcoholic beverages. Overweight was detected in
47.5% of seamen (49.1% of Lithuanian and 45.9% of
Latvian, p = 0.086), 51.8% of seamen (46.1% of Lithuanian and 57.5 of Latvian, p < 0.001) experienced psycho-emotional stress, and 19.0% experienced depression.
Fewer Latvian seamen, compared to Lithuanians, consumed alcohol (OR = 0.60; 95% CI 0.50–0.72;
p < 0.001), were obese (OR = 0.58; 95% CI 0.43–
0.79; p < 0.001) and had AH (OR = 0.25; 95% CI
0.12–0.52; p < 0.001).
Table 2 presents odds ratios (OR) on whose basis
we evaluated the differences in the prevalence of risk
factors (self-reported) of chronic non-infectious diseases among Lithuanian and Latvian seamen adjusting for
age differences. The differences in the prevalence of
smoking and physical exercise were no statistically significant. Adjusting for age, the analysis showed that
Table 2. Odds ratios of the prevalence of risk factors for chronic non-infectious diseases among Lithuanian and Latvian
seamen (Latvia with respect to Lithuania, age-adjusted OR)
Risk factors
Age, 1 year
Smoking
Alcohol consumption
Body mass index
normal#
overweight
obesity
Daily exercise
every day#
2–6 times/week
4–2 times/month
no exercising
Hypertension
Hypercholesterolemia
Psycho-emotional stress
Subjective health (worse than “good”)
Prevalence N (%)
Age-adjusted
OR (95% CI)*
Lithuania
Latvia
460 (46.1)
584 (58.5)
540 (54.8)
476 (48.2)
0.99 (0.98–1.00)
1.08 (0.90–1.29)
0.60 (0.50–0.72)
508 (50.9)
365 (36.6)
125 (12.5)
539 (54.7)
383 (38.8)
75 (7.6)
1
1.01 (0.83–1.23)
0.58 (0.43–0.79)
p
0.47
<0.01
<0.001**
<0.001**
150 (15.0)
302 (30.3)
293 (29.4)
252 (25.3)
37 (3.7)
6 (0.6)
461 (46.2)
343 (34.4)
114 (11.6)
345 (35.0)
301 (30.5)
240 (24.3)
10 (1.0)
5 (0.5)
573 (58.1)
444 (45.0)
1
0.75 (0.55–1.03)
1.11 (0.87–1.41)
1.04 (0.82–1.33)
0.25 (0.12–0.52)
0.95 (0.27–3.34)
1.66 (1.39–2.00)
1.55 (1.28 – 1.89)
*Odds ratio statistically significant when 1 was not included into its 95% confidence interval.
**p for trend.
#
Reference category.
<0.001
0,500
<0.001
<0.001
43
Health problems of Lithuanian and Latvian seamen
fewer obese seamen as well as those consuming alcohol were among Latvians; Latvian seamen more frequently experienced psycho-emotional stress, and the cases of AH among them were less frequent.
The differences in the habits and risk factors of
chronic non-infectious diseases between Lithuanian and
Latvian seamen conditioned the subjects’ attitude towards their health. There were 1.5 times more Latvian
seamen who evaluated their health worse than “good”,
compared to Lithuanians. Lithuanian seamen more frequently (48.6%) evaluated their physical capacity as “good”, versus only 38.7% of Latvian seamen; this difference may have been influenced by a significantly greater frequency of physical exercising among Lithuanians.
Retrospective analysis of seamen’s medical documentation
The health disorders experienced at sea that were indicated by seamen more reflected short-term health disorders, whereas a retrospective analysis of the seamen’s
medical documentation allowed for a better understanding of the seamen’s real morbidity and tendencies (1,
2, 11). The evaluation of the differences in the morbidity between Lithuanian and Latvian seamen did not
reveal any significant differences.
About 0.8% of seamen had diabetes mellitus (DM)
(E11, E12), 0.5% had compression of nerve roots and
plexuses (G55), 1.6% had ocular diseases (H40, H52,
H52.1, H53.5), 1.9% – auricular and auditory disorders
(H74.1, H90.1, H90.3), 6.0% – cardiovascular diseases
(I10, I11, I15, I25, I48, I83, I84), 0.25% – chronic
bronchitis (J42), 0.7% – gastric and duodenal ulcers
and gastritis (K25, K26, K29), 0.7% – loin pains
(M54.4), and 1.5% – urethritis and prostatitis (N34,
N41) (Fig. 4).
The prevalence of diagnosed diseases among seamen of both countries was homogeneous (Levene test
3.635, p = 0.067), and the differences were statistically
insignificant when adjusting for age differences, therefore the whole contingent of seamen was analyzed (N
= 1984). The majority of the diagnosed diseases were
CVD (6%), ocular and auditory diseases (1.6 and 1.9%),
and urogenital diseases (1.5% of cases). The rest were
diseases of the endocrine system (3%), metabolic disorders (0.8%), and diseases of the nervous (0.5%), respiratory (0.3%), digestive (0.7%), connective tissue and
musculo-skeletal system (0.7%).
The correlation analysis of diseases diagnosed according to the ICD-10 criteria showed a statistically
significant association of their prevalence with age (each
year of age increased the risk of diseases by 7%, OR
= 1.07; 1.05–1.08), the professional group, the length
of service, and the duration of smoking. Analysis of
the prevalence of individual cases of diseases showed
that the following diseases were related to age: ocular
(OR = 1.06; 1.02–1.09), auditory (OR = 1.03; 1.02–
1.07), cardiovascular (OR = 1.08; 1.06–1.10), and urogenital (OR = 1.11; 1.06–1.16); the risk of such diseases in seamen increased by 2 to 16% with each year
of life. The length of service was associated with diseases of the nervous, cardiovascular, respiratory and urogenital systems. We found diseases of the cardiovascular, digestive and urogenital systems to be associated
with the duration of smoking, while the auditory and
10
Lithuania
6.3
%
Latvia
5.7
5
0.8
0.7
0.7 0.3
1.7 1.4
1.8 2
0.3
0.2
0.8 0.6
0.8
0.6
1.3
1.6
0
Metabolic
ICD group
IV_E
Nervous
system
VI_G
Ocul
Auditory
VII_H
VIII_H
Cardiovascular
system
Respiratory
system
IX_I
Digestive
system
X_J
Musculo-skeletal
XI_K
Urogenital
system
XIII_ M
Fig. 4. Morbidity of Lithuanian and Latvian seamen
20
15
18.2 18.1
13.8
14
13.4
15.2
16.4
12.9
Lithuania
Latvia
9.7
% 10
5
0
Management sector
Mechanical ship
service
Deck crews
Fig. 5. Diagnosed cases of diseases in different professional groups
Auxiliary sector
All
XIV
44
Jonas Sąlyga, Algirdas Juozulynas, Aloyza Lukšienė
10
%
9
p < 0.05
8
7
6
5
4
p < 0.001
*
3
*
2
1
*
0
Metabolic
Nervous system
Management sector
Ocular
Auditory
Cardiovascular
system
Mechanical ship service
Respiratory
system
Deck crews
Digestive
system
Musculo-skeletal
Auxiliary sector
Urogenital
system
All
* p < 0.05 the level of significance of difference among professional groups
Fig. 6. Prevalence of diagnosed diseases in seamen’s professional groups
cardiovascular diseases were related to the professional
group.
Analysis of the distribution of the diagnosed diseases according to the position occupied and when controlling for age did not yield any significant difference
between Lithuanian and Latvian seamen, although the
morbidity of the Latvian mechanical ship service and
deck crews was lower than that among Lithuanian seamen (Fig. 5). According to the data of the seamen’s
medical documentation, 13.8% of seamen of both countries were diagnosed with various diseases. Most diseases were diagnosed among seamen of the management (18.2%) and auxiliary (15.7%) sections; fewer diseases were found among the mechanical ship services
(13.7%) and deck crews (11.3%).
Figure 6 presents the distribution of separate diagnosed diseases according to professional groups (adjusted for age differences). With the exception of auditory
diseases and diseases of the cardiovascular system, professional groups exhibited similar health profiles.
We found that cardiovascular diseases were more
common among seamen of the management (9.2%) and
auxiliary sectors (7.9%) (p < 0.05, after adjusting for
age differences). The difference in the prevalence of
these diseases among seamen of the management sector
and mechanical service (5.2%) and deck crews (5.0%)
was statistically significant (p < 0.05).
Ear diseases were more frequently diagnosed among
seamen of the mechanical ship services (3.1%; p <
0.05, versus deck crews – 0.6%). Such diseases were
more common among the seamen of the managerial
(2.0%) and auxiliary (1.6%) sectors compared to deck
crews (0.6%).
The distribution of other diagnosed diseases according to professional groups was not statistically significant, but eye diseases (Levene homogeneity test 3.7,
p < 0.05) more frequently than usual (1.6%) were diagnosed among seamen of the managerial sector (2.5%).
Diseases of the digestive system were also more common in this group (1.1%) than in other professional
groups. Diseases of the urogenital system (1.5%) were
more common among seamen of the auxiliary sector
(2.7%) and the mechanical ship service (1.8%) (Levene
homogeneity test 4.027, p < 0.01). Diseases of the connective tissues and the musculo-skeletal system (0.8%)
were common among deck crews (0.9%) and seamen
of the managerial (0.8%) and auxiliary (0.8%) sectors.
Diseases of the respiratory tract and the nervous system were least common among deck crews – these
seamen were more frequently diagnosed with diseases
of the metabolic system, compared to other professional groups. Seamen working in the auxiliary sector more
frequently had diseases of the nervous system, compared to seamen of other professional groups (0.8%). The
evaluation and standardization of the obtained findings
and seamen’s self-reported other risk factors showed
that the relationships were either very weak or absent.
In conclusion, the occurrence of auditory problems
in engineers is consistent with findings of previous maritime studies. Although this condition is a common
problem for engineers, strict implementation of guidelines for exposure to noise levels in industry would impact the incidence of auditory problems (7). Several
studies have shown that health problems in the maritime industry especially include ergonomic diseases as
well as attrition, hearing-handicap, musculoskeletal and
cardiovascular diseases. Furthermore, these are the results of special psychosocial conditions with an increased occurrence of tiredness, stress and psychic symptoms (6, 7, 10, 11, 13).
We examined the occurrence of important lifestyle
and risk factors for ill-health such as arterial hyper-
Health problems of Lithuanian and Latvian seamen
tension (AH), immoderate use of alcoholic beverages,
smoking, increased blood cholesterol levels, insufficient physical activity. In addition to these factors,
there are other specific factors that affect seamen’s
health and lifestyle. Although on the international level studies on seamen’s health in different sectors of
business have been performed for a number of years,
there is still a lack of knowledge about the working
environment, injuries and diseases on the ships, and
thus the majority of maritime studies emphasize the
necessity of the renewal of knowledge in this area
(42, 1054, 105). According to the recommendations
of the World Health Organization (WHO), studies on
the working environment of different professional
groups of coast workers have been performed for over
30 years, the recommendations are being implemented, while similar research in maritime business is only in its initial stage. As the result of the cooperation
between the WHO and the International Labor Organization (ILO), a new strategy of maritime studies has
been adopted in Geneva in 1997 (4, 5). The strategy
recommended that physicians would learn about the
seamen’s living and working conditions on the ship
during the compulsory health check-ups. One of the
main tasks was research on the relationship between
seamen’s health and the working environment. Detailed
information about the seamen’s working and resting
conditions is necessary, since only sufficient knowledge may allow for early detection of health disorders
and diseases and for a timely application of effective
preventive measures (1–3). In our study, 56.0% of Lithuanian and Latvian seamen indicated that the main
cause of morbidity was the work at sea being exposed
to health-damaging factors. Future studies should therefore pay special attention to estimating associations
or cause and effect relationship between the occurrence of a disease and high stress, poor environmental
conditions, and critical traffic conditions.
CONLUSIONS
There was no statistically significant difference between Lithuanian and Latvian seamen concerning the frequency of diagnosed diseases – 13.8% of seamen
(14.5% of Lithuanian and 13.1% of Latvian) were diagnosed with various diseases. The diseases related to
seamen’s professional group were cardiovascular and
auricular diseases. These diseases were least common
among deck crews, but these seamen, compared to those of other professional groups, were more frequently
diagnosed with diseases of the connective tissue and
the musculo-skeletal system. They also presented better
subjective evaluations of their health status. There is
no doubt that a comprehensive health promotion work
is important to seafarers.
Received 29 June 2005
Accepted 13 January 2006
45
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38.
Jonas Sąlyga, Algirdas Juozulynas, Aloyza Lukšienė
LIETUVOS IR LATVIJOS JŪRININKŲ SVEIKATOS
PROBLEMOS
Santrauka
Vienkartinis nacionalinis jūrininkų gyvensenos ir sveikatos tyrimas buvo atliktas 2003 m. lapkričio–gruodžio mėn. pagal
tarptautinę Lietuvos ir Latvijos suderintą metodiką, kurio metu įvertinta ir palyginta jūrininkų darbo aplinka, gyvensena,
46
Jonas Sąlyga, Algirdas Juozulynas, Aloyza Lukšienė
sveikata, sveikatą žalojančių rizikos veiksnių paplitimas, objektyvios bei subjektyvios sveikatos vertinimo ir patiriamos jūroje psichoemocinės įtampos prie astiniai ry iai. io darbo tikslas – įvertinti subjektyvią bei objektyvią Lietuvos ir Latvijos
jūrininkų sveikatos būklę.
Mūsų tyrimo duomenimis, trečdalis (34,3%) Lietuvos jūrininkų savo sveikatą įvertino blogiau nei „gera“. Tarp pagrindinių, su sveikatos būkle jūroje susijusių problemų Lietuvos ir
Latvijos jūrininkai nurodė skausmą (dantų, galvos, juosmens,
sąnarių), nemigą ir lėtines ligas – arterinę hipertenziją, skrandžio ir dvylikapirštės žarnos opaligę, artritą, stuburo ligas,
bronchitą ir kt. Kaip pagrindinę sergamumo priežastį 56,0%
Lietuvos ir Latvijos jūrininkų nurodė darbą jūroje veikiant sveikatai žalingiems veiksniams. Diagnozuotų ligų dažnis tarp Lietuvos ir Latvijos jūrininkų statistiškai reikšmingai nesiskyrė: bu-
vo nustatytos ligos 13,8% jūrininkų (14,5% Lietuvos ir 13,1%
Latvijos jūrininkų). Vienodai dažnai abiejų šalių jūrininkams
diagnozuotos kraujotakos sistemos (6,0%), ausų (1,9%), akių
(1,6%), urogenitalinės sistemos (1,5%) ligos, cukrinis diabetas
(0,8%), opaligė (0,7%). Su jūrininkų profesijos grupe buvo susijusios kraujotakos sistemos (p < 0,05) ir ausų ligos (p <
0,001): kraujotakos sistemos ligos dažniau diagnozuotos vadovaujančios (9,2%) ir pagalbinės grandžių jūrininkams (7,9%),
tuo tarpu klausos sutrikimai da niau vargino mechaninės laivo tarnybos jūrininkus (3,1%; p < 0,05, lyginant su denio komanda – 0,6%). Denio komandos jūrininkai šiomis ligomis sirgo retai, jiems dažniau nei kitų profesinių grupių jūrininkams
pasireiškė jungiamojo audinio, skeleto ir raumenų ligos, taip
pat jie geriau ir subjektyviau vertino sveikatos būklę.
Raktažodžiai: jūrininkai, sveikata, rizikos veiksniai